AF Ablation and Gender Differences in Outcomes
How do outcomes of women differ from those of men undergoing catheter ablation for atrial fibrillation (AF)?
The medical claims of 45 million patients enrolled in either employer-sponsored or fee-for-service health plans were analyzed. Among these patients, those who underwent a catheter ablation procedure for AF (n = 21,091) between 2007 and 2011 were identified. The primary endpoint was the incidence of post-procedure complications occurring within 30 days of the ablation procedure.
Women undergoing the catheter ablation procedure for AF tended to be older (62 vs. 58 years), had a higher CHA2DS2-VASc score (2.9 vs. 1.6), and were afflicted with more comorbidities as compared to men. The incidence of post-procedure hemorrhage (2.7 vs. 2.0%), and pericardial tamponade (3.8 vs. 2.9%) was higher in women. During 1 year of follow-up, women were more likely to be hospitalized for AF (13 vs. 12%), but were less likely to undergo cardioversion (17 vs. 21%), and redo ablation procedure (13 vs. 15%).
The authors concluded that women were more likely to experience bleeding complications after an AF ablation procedure, and were less likely to undergo a repeat ablation despite a higher readmission rate for AF after the procedure.
In general, women seem to be at higher risk of experiencing vascular complications after various percutaneous cardiovascular procedures. The precise mechanism is unclear, but it is conjectured that vessel size is smaller in women, posing a higher risk of hemorrhage, especially when multiple catheters are inserted into a single vein. These data should exhort the electrophysiologist to minimize the number of access sites/catheters, using only those that are essential. Further, the smallest caliber sheaths should be utilized. Other possibilities are that women undergoing the procedure were older. Advancing age may in part help explain a higher risk of complications. It is not clear why women were less likely to undergo repeat procedures. Possibilities include reluctance both on the part of the patient and the physician, and other sociological factors.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Tamponade, Catheter Ablation, Electric Countershock, Fee-for-Service Plans, Hemorrhage, Patient Readmission, Treatment Outcome
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